What to do when Heller's myotomy fails? Pneumatic dilatation, laparoscopic remyotomy or peroral endoscopic myotomy: A systematic review
Por:
Fernandez-Ananin, S, Fernandez, AF, Balague, C, Sacoto, D, Targarona, EM
Publicada:
1 jul 2018
Resumen:
Background: Surgical treatment of achalasia fails in 10%-20% of patients. The most frequent responsible cause is the performance of an incomplete myotomy at primary surgery. The treatment when the failure happens is not well defined. In this study, we review and evaluate the possible treatments to be carried out when surgical myotomy fails. We define its benefits and results, with the purpose of defining a therapeutic algorithm.
Materials and Methods: The systematic review was performed following the guidelines established by the Meta-analysis of Observational Studies in Epidemiology statement. We searched several electronic databases ( MEDLINE, PubMED, EMBASE and Cochrane) from January 1991 to March 2017, with the keywords 'recurrent achalasia' 'POEM remyotomy', 'esophagomyotomy failure', 'Heller myotomy failure', 'myotomy failure', 'pneumatic balloon dilatation achalasia' and combinations between them, 'redo Heller', 'redo myotomy', 'reoperative Heller'.
Results: A total of 61 observational studies related to the treatment of patients with failure of Heller's myotomy were initially found. Finally, 37 articles were included in our study that provided data on 289 patients. Of these 289 patients, diagnosed of failed Heller's myotomy, 87 were treated with pneumatic dilatation (PD), 166 underwent surgical revision and finally 36 were treated with POEM. No randomised controlled trial was identified.
Conclusions: The three therapeutic options analysed in this review are effective and safe in the treatment of patients with achalasia with failure of surgical myotomy. The best results can be achieved following an algorithm similar to the one proposed here, where each procedure must be performed by well-experienced team in the selected modality.
Filiaciones:
Fernandez-Ananin, S:
Autonomous Univ Barcelona, Hosp De La Santa Creu Sant Pau 1, Dept Gen & Digest Surg, Barcelona, Spain
Fernandez, AF:
Hosp Quiron Teknon, Ctr Laparoscopico Dr Ballesta, Dept Gen & Digest Surg, Barcelona, Spain
Balague, C:
Autonomous Univ Barcelona, Hosp De La Santa Creu Sant Pau 1, Dept Gen & Digest Surg, Barcelona, Spain
Sacoto, D:
Autonomous Univ Barcelona, Hosp De La Santa Creu Sant Pau 1, Dept Gen & Digest Surg, Barcelona, Spain
Targarona, EM:
Autonomous Univ Barcelona, Hosp De La Santa Creu Sant Pau 1, Dept Gen & Digest Surg, Barcelona, Spain
Gold, Green Published
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